State Leadership Conference
Current Procedural Terminology (CPT) codes can help psychologists expand their practice purview, making it easier to provide quality patient care, said panelists at a 2006 State Leadership Conference workshop.
Michael Goldberg, PhD, president of the Massachusetts Psychological Association, spoke about the advantages of the six health and behavior codes established in 2002. CPT refers to a system of codes that apply to any medical or health-related service and are used by almost all third-party payers-including Medicare, Medicaid and private carriers. The new health and behavior codes-the 96150 through 96154 series-allow psychologists to bill for assessments and interventions related to a physical, rather than mental, health problem. Reimbursement for these services under Medicare comes from medical rather than mental health funds, giving providers greater flexibility when it comes to the number and length of patient visits, he added.
However, since the codes are relatively new, many private insurance carriers do not know how to apply them or are picking and choosing which ones they will pay for, said Goldberg, which means that providers need to advocate on behalf of psychology and their patients. He suggested that providers explore using existing laws, such as those related to prompt payment, mandated benefits or freedom of provider to pressure insurance companies to recognize and implement the health and behavior codes. He also recommended choosing when possible to do business with companies that treat their clients fairly, and working with APA and state psychological associations on issues that arise with private carriers.
Jennifer Morgan, PsyD, a member of the Virginia Psychological Association and the National Academy of Neuropsychology, said that in Virginia, she successfully negotiated for private insurance coverage of the recently revised psychological and neuropsychological testing codes through the Virginia Psychological Association's relationships with insurance carriers. Morgan pointed out that association members already sit on many private insurance companies' carrier advisory boards.
Presenters at the session also explained that new CPT testing codes for psychological and neuropsychological testing for the first time make a distinction between who is doing the testing-the psychologist, a technician or a computer. Under the codes, psychologists interpret all tests, regardless of how they are administered. Psychologists can now bill Medicare, Medicaid or private carriers at a professional rate for any time they spend administering or interpreting tests.
If private insurance carriers refuse to pay for some of the new testing codes, psychologists can contact the carrier's medical director or carrier advisory committee, suggested Kimberley Moore, a federal regulatory officer in APA's Practice Directorate. If that route proves unsuccessful, practitioners can contact the Practice Directorate, she advised.
By entering the arena of health care, psychologists will be able to give more and better care to their patients, concluded Antonio E. Puente, PhD, a psychology professor at the University of North Carolina, Wilmington, and APA's representative to the CPT Health Care Professionals Advisory Committee.